On World AIDS day last week, the American College of Physicians announced new practice guidelines that call for doctors to encourage all of their patients to be tested for HIV. They join other doctor groups in endorsing a federal Centers for Disease Control and Prevention recommendation that everyone ages 13 to 64 be screened for HIV infection.
HIV is the virus that causes AIDS, and the most recent CDC data suggest that more than 1 million Americans carry the virus, including more than 50,000 who were newly infected in 2006. That year, the CDC devised its new "opt out" strategy for HIV testing. The next time you see a doctor, whether for a physical exam or a specific complaint, he or she may say, "Let's test your blood for cholesterol, glucose and HIV." In the past, the HIV screening suggestion would have been limited to high-risk patients such as intravenous drug users and gay and bisexual men.
Why the change? For starters, the previous approach too often failed to identify new infections, says Dr. Bernard Branson, of an HIV/AIDS prevention division at the CDC, who was instrumental in developing the current recommendations. For example, a CDC project on emergency room admissions showed that when the decision to screen for HIV was based on a patient's profile, one out of two infected people were not identified.
In addition, recommending the test for everyone circumvents a cumbersome and often awkward conversation between doctors and their patients. Under the old system, doctors had to ask a host of sensitive questions simply to determine if a person fell into one of the high-risk groups that should be tested, an uncomfortable and time-consuming task. Now, rather than asking about their patients' sex lives, doctors can recommend testing as routine medical care.
Why should teenagers and married women, to name two traditionally low-risk groups, be screened for HIV status? Because, increasingly, HIV is transmitted through heterosexual contact, Branson says -- and also, because patients can benefit. It's known that as many as one in four people who are infected with HIV don't know it -- but it's also known that therapy works best when it is started before a patient shows symptoms of AIDS.
Thus, people who are identified as HIV-positive early and get medical treatment can delay their progression to AIDS and live longer.
